| NPI | 1336673219 |
|---|---|
| Former Name | TABATHA WYDRYCK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY 06040) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 5101025608) |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2025-10-22 |